No prescription necessary

You can stop an overdose with this drug


TALLAHASSEE – Florida’s fight to slow the death toll from heroin and prescription opioids is about to get a major boost.

In Baltimore City, Md., heroin addicts who visit a needle exchange van are given instructions on how to use naloxone (also called Narcan) to reverse heroin overdoses.(AMY DAVIS/BALTIMORE SUN/TNS)
In Baltimore City, Md., heroin addicts who visit a needle exchange van are given instructions on how to use naloxone (also called Narcan) to reverse heroin overdoses.

In March, Florida joined nearly 40 other states in making the overdose-reversal drug naloxone available at pharmacies without an individual prescription.

The new law takes effect July 1, and police and health experts say the expanded access will help slow the barrage of fatal overdoses stemming from Florida’s outsized appetite for heroin, Percocet, hydrocodone and other powerful prescription painkillers.

‘Fire extinguisher’ for ODs
“People who are shooting heroin are playing with fire, and I often make the analogy that naloxone is the fire extinguisher,” said Mark Sylvester, an addiction psychologist in the Bradenton area.

“Naloxone will save lives. It will make a difference,” Sylvester said. “And I base that not only on the scientific evidence but also on my personal experience as a clinician and having saved countless lives” with naloxone.

Thousands of overdoses
In 2014, Florida hospitals handled nearly 12,000 prescription opioid overdoses and 1,925 heroin overdoses, said Jim Hall, an epidemiologist at Nova Southeastern University who studies substance abuse.

Heroin deaths were up 100 percent in Miami-Dade in the first half of 2015 compared with the same period from 2014, according to a recent state report.

Wider availability and use of naloxone could help bring those numbers down.

“Florida’s making it available to anyone is a major step forward in the opiate pandemic,” Hall said.

1,200 dead
A class of narcotic pain medications, opioids include prescription drugs such as morphine, fentanyl and oxycodone, which collectively killed 950 people in Florida in the first half of 2015, state figures show. Heroin, an illicit opioid, killed another 320 Floridians over the same period.

Opioids reduce the perception of pain by attaching to proteins in the brain called opioid receptors.

When naloxone is sprayed into the nostrils or injected, it knocks the opioid off the brain receptors and keeps it from binding with other receptors.

This allows patients to regain their breath by reversing the deadly effects of opioid overdose: suppression of the respiratory and central nervous systems.

People who take prescription opioids and who aren’t addicted – and their loved ones – should also keep naloxone around in case of accidental overdose, when time is of the essence, said Dr. Ihsan Salloum, chief of the division of substance and alcohol abuse at the University of Miami Health System.

“The brain is extremely sensitive to a lack of oxygen, so a few minutes can make the difference between life or death or permanent brain damage, Salloum said. “It’s very important to reverse the overdose as fast as you can.”

Routinely carried
Naloxone and its brand-name version, Narcan, are now standard equipment for most paramedics.

Many police officers carry the medication as well.

Naloxone provided by community overdose-prevention programs alone stopped more than 26,000 opioid overdoses from 1996 to 2014, the Centers for Disease Control and Prevention reported last year.

As the nation’s heroin epidemic worsens, states across the country are easing restrictions on the availability of naloxone. Last year, Florida Gov. Rick Scott signed legislation allowing doctors to prescribe it to the families and friends of addicts.

Easy availability
Florida’s new law will use a “standing order” to make the medication available to the general public without individual prescriptions.

A “standing order” is like a contractual agreement in which a physician sets the terms and conditions for a pharmacy to provide naloxone, said Michael Jackson, the executive vice president and CEO of the Florida Pharmacy Association.

“It is sort of a prescription,” Jackson said. “There’s a prescription that’s issued. But that prescription says you can dispense this drug to patients who are meeting (certain) qualifications. So it’s not patient-specific.”

It’s the same arrangement that allows pharmacies to administer vaccines and immunizations without requiring prescriptions, Jackson said.

Each pharmacy chain or independent pharmacy will have to secure its own standing order for naloxone. That means different pharmacies can have different requirements for people to purchase it. Typically, those requirements are minimal.

Beginning July 1, pharmacists at Florida’s 878 CVS Pharmacy locations will simply counsel buyers on how to use naloxone, how to recognize the signs of overdose, and the importance of calling 911 after usage and staying with the patient until help arrives. CVS pharmacists must be satisfied that buyers understand those terms before they dispense the medication.

“I would suspect that many of the (pharmacy) chains will do the same,” Jackson said. Independent pharmacies will establish their standing orders through local doctors, he said.

The injectable naloxone kit sells for about $45 at CVS. The intranasal version costs about $90.

Patients should contact their health insurance companies to see whether the drug is covered.

Not a cure
It’s essential that patients get medical care after receiving naloxone since the drug can wear off within 90 minutes, depending on how much heroin or prescription opioids are in their system.

CVS Pharmacy already sells naloxone without a prescription in 25 states through either a standing order or a collaborative practice agreement between pharmacists and other health care providers.

That number will grow to 30 states by the end of summer, once similar sales begin in Florida, Colorado, Idaho, Oregon and Washington.

Walgreens plans to do the same in 35 states and Washington, D.C. It’s unclear when its Florida stores will do so.

Behavioral change crucial
While some might be concerned that having naloxone may cause addicts to be more reckless with their drug use, Sylvester, the addiction psychiatrist, said research hadn’t shown that.

“Believe it or not, they don’t do that,” Sylvester said of opioid addicts. “That’s what you and I would do, but you and I don’t think like drug addicts.”

Salloum and Hall said any overdose should be viewed as an opportunity to get the patient into counseling or treatment.

“Overdose poisoning is a sign that death will very likely be occurring if this person does not change the behavior that brought them to that,” Hall said.


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